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The progress in electronic health delivery during the past few years puts Canada in a promising position, says a vision paper prepared by Canada Health Infoway Inc. on the future delivery of medical services.

The paper outlines what sufficient funding and government co-operation could accomplish by 2015 by employing information technology to enable more effective use of health care facilities, especially during a time when an aging population is bound to stress the system’s capacity.

There remain obstacles to overcome, the paper asserts. Among them is “the lack of a truly compelling story for politicians, physicians and the public about the urgent and crucial need to build the health infostructure.” The case for e-health suffers from “an inability to fully illustrate the impact and provide proven case studies [of its benefits].”

Then there is “inconsistent and sometimes insufficient commitment by governments to fund the completion of the infostructure,” the paper notes.

Richard Alvarez, president and CEO of Infoway, believes public endorsement of IT’s use in health care is a matter of time. The spread of electronic health records (EHRs) and the growing public comfort with using the Internet will translate into an expectation that the health care system will have all the required information about individuals readily available.

“Why should we have to repeat our basic medical information over and over, wait for laboratory tests to be delivered to our doctor or remember all the medications we are on?” he says.

At the same time, e-health supporters “have not done a good job of working with consumer and seniors groups to show them what can be done.”

By way of comparison, he notes that banks are all highly automated with online service for their customers. “It took them a long time to get where they are now.” It will be the same for e-health. “Let’s finish what we started; it will have a profound impact.”

The paper suggests several goals for e-health development beyond the rollout of a national EHR system and building political and public support. These include better disease management and cancer care systems, enhanced pandemic and public health services, more extensive remote care and shorter wait-times.

“Without an integrated IT infostructure, Canada will struggle to meet the increasing demands of all its stakeholders to deliver superior care at a sustainable cost,” the paper asserts.

It will take another $10 billion to $12 billion in capital investment over the next decade to produce an integrated e-health system, but that would amount to about two per cent of Canada’s annual public health care funding.

That level of IT spending would be slightly below what other information-intensive industries now invest annually. It would also produce major savings in health care without sacrificing the quality of patient care.

In fact, it could produce improvements, Alvarez says. Consider a senior who is on various prescription medicines and ends up in a hospital bed because of an adverse reaction. Under an e-health system, the senior’s list of drugs would be online and a pharmacist or doctor could intervene to prevent an unhealthy combination of pills and the senior is spared the trip to hospital.

Michael Green, president and CEO of Agfa Canada Inc., says the vision paper seems to be headed in the right direction for greater use of IT in health care. “The funding provided to Infoway has certainly stimulated provincial governments to invest in technology,” he says, adding that Infoway has put EHRs on the agenda of every provincial minister.

Getting public endorsement for e-health may simply be a matter of overcoming the perception that an integrated EHR system already exists, he suggests. That’s because the doctor’s office uses a computer and so does the hospital. That there’s no connection between them has yet to be understood.

Ottawa-based IT consultant John Davis says the rationale in support of e-health is well known. What isn’t appreciated is the need to have a business driver to create systemic change in the $100-billion health care system to reduce the administrative costs which could make it unsustainable over time.

The business case for e-health has to be made from the bottom up to reduce costs throughout the system without lessening service, suggests Davis. At the same time, health care requires consistent political support from the federal and provincial governments so that changes will be completed.

Health care has to learn to reduce, reuse and recycle its information requirements to make better decisions, he says. Change should begin at the hospital level and move from there to individual physicians.